Click Here to listen to Dr. Cline's 2 minute audio clip on the dangers of over-reassurance which includes examples of effective and ineffective ways to respond to a worried child.
The Difficult World of Cold, Hard Facts by Foster Cline, MD
A mother with a child growing up with cystic fibrosis takes him to the clinic. Children with cystic fibrosis shouldn’t lose weight. But Eric has lost a little weight. Not much, but he has exhibited a laissez-faire attitude about eating at home and now it shows in the lost pounds. At the clinic, after examining the personable and enjoyable 12-year-old, the doctor says, "Eric you are doing fine."
The mom feels disappointed and unsupported. She thinks, "This kid has charmed the doc into getting reassurance that subtly okays behavior that could lead to an earlier death." It is difficult at home to tell Eric that he needs to eat more and keep up his weight when he wants to skip the breakfast. Erik naturally replies, "The doctor says I'm doing fine."
When dealing with self health decisions, medical professionals sometimes feel caught in a bind between being approving and supportive and being critical; between being hopeful and being unnecessarily cruel; between being scrupulously honest and being reassuring.
Blogs on the Internet are filled with comments from unhappy parents and their experience with medical professionals:
"The doctor keeps pushing me to ensure that Jane takes better care of herself and I am doing all I can."
One wrote, "I don't want them to say things that could frighten my child."
And then of course there are others that, like Eric’s mother, insist on physicians giving the hard facts.
What’s the right thing for a health professional to do? Often, of course, the answer is in the delivery. It comes down to "bedside manner". The facts may be hard but the delivery doesn't have to be cold. Facts can be given in a manner that is more caring than blunt; more encouraging than critical.
Love and Logic principles build character by assuming that children have the strength and ability to handle the absolute truth when it is given in a loving and caring manner. Love and Logic also emphasizes that when parents and professionals are unsure of exactly what to say, they generally should ask a question. When professionals or parents relate caringly through thoughtful questions, the correct path between over reassurance and harsh facts is clear. In fact, Love and Logic uses questions as an encouragement tool.
In the present case, a little questioning could have led to a conversation that encourages weight gain but doesn’t sound judgmental or critical. Let us look at a couple of examples that demonstrate professional questioning when a child responds:
1) With honestly
2) When overly-optimistic
3) self-critically:
1) "Eric, what are your thoughts about your weight?"
"Well, it's just down a little bit."
"What are your thoughts on that?"
"My mom says I should try a little harder to eat more."
“Do you think that's good advice?"
“Probably."
“Why is that?"… and on with a review about the importance of weight.
2) "Eric, what are your thoughts about your weight?"
"It's fine."
"What do you mean by fine?"
"Well, I've only lost a little bit of weight."
“I'm wondering if a kid as wise as you should be completely satisfied with that? I guess you know what I am getting at." … and on with a review about the importance of weight.
3) "Eric, what are your thoughts about your weight?"
"I'm doing a lousy job."
"What do you mean by that?"
“I've lost too much weight.”
“Well, you have lost a few pounds. But shoving down food when you're not really hungry takes a lot of fortitude. I have seen lots of kids who don't do as well as you. So I wouldn't be too hard on myself but I am pleased that you see the need for improvement. Do you think you're the kind of kid who will probably improve or do you see yourself as a kid who doesn't care quite that much?” … and on with an understanding discussion of reasons for letting things slip and on with a review about the importance of weight.
In summary, Love and Logic encourages providing children with the cold, hard facts with a warm, soft delivery while encouraging self examination and honesty through caring questions.
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Foster W. Cline, MD is a well-known child psychiatrist and co-founder of Love and Logic. Lisa Greene is the mom of two kids with cystic fibrosis and a parent coach. They have written the award-winning book “Parenting Children with Health Issues: Essential Tools, Tips and Tactics for Raising Kids with Chronic Illness, Medical Conditions and Other Special Needs” available at www.loveandlogic.com.
For free audio, articles and other resources, visit http://www.ParentingChildrenWithHealthIssues.com.
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